Humana, FL Physicians Group Bundle Radiation Services

In following the care paths, the physicians want to determine that the clinical outcomes are improving. One of the outcomes 21st Century wants to measure is the frequency of treatment interruptions related to the toxicity of radiation therapy.

Mantz explains, for example, that if a breast cancer patient has a significant skin reaction or other complication due to radiation therapy and has to stop treatment, the interruption could result in an unwanted outcome in terms of disease control.

Mantz says his group also hopes to simplify billing and payment on the provider and payer side by replacing the multiple filing and billing often associated with claims with a simple trigger that signals payment is due.

He adds that radiation therapy has a high number of codes associated with a course of care, which complicates the claims process. Radiation therapy for breast cancer can involve 20 to 25 different types of services, each with its own unique current procedure terminology (CPT) code. Bundling eliminates the need to obtain separate approval for each one.

The 13 bundles under the Humana contract cover about 80% of all of the diagnoses that are treated with radiation therapy. In the future, 21st Century wants to develop bundles that will be inclusive of every diagnosis and reduce the total number of bundles. The Humana contract includes some trial efforts to determine how the bundles can be more inclusive and simpler.

Humana did not respond to requests for information about its bundling program.